The application of artificial intelligence in the acute and sub- acute phases of spinal cord injury- a systematic review

STUDY DESIGN: Systematic Review. OBJECTIVE: To describe applications of AI for traumatic SCI management with focus on diagnostics, prognostication, and therapeutic interventions. METHODS: PubMed, Scopus and Cochrane libraries were searched (March 2025). Studies published in English between January 1st , 2020, and March 18, 2025, dealing with clinical aspects in the acute, post-injury rehabilitative and rst year phases of SCI were included. Studies on brain computer interface, robotics and non-neurologic aspects of SCI were excluded. Extracted were country of study, study design, focus of study, total participants, American Spinal Injury Association (ASIA) Impairment Scale (AIS), machine learning (ML) models, inputs, outcomes and performance metrices. RESULTS: A total of 23 studies with 120,931 individuals were identi ed. Classical Machine Learning Models, Ensemble Learning Models and Deep Learning Models were the most used ML families. Age, AIS, neurologic level of injury, sex, mechanism of injury and motor score were the most common inputs. Predictions of neurologic status, functionality status, Hospital/ICU utilizations, complications, survival, discharge destination and results of image segmentation and patient grouping were the outputs of interest. The performance metrices were satisfactory in most and higher than humans in some studies. CONCLUSION: AI can facilitate personalized approach to diagnosis of SCI, prediction of outcomes like neurological improvement, complications, functionality indicators like walking, selfcare and independence, re-admissions, prolonged length of stays, discharge destination and mortality after injury. It was also useful to suggest speci c MAP goals and time of surgical intervention. These functions complement clinical judgement.